Are We Ready?

Public Health since 9/11

David Rosner

Publication Year: 2006

A contemporary history of a critical period, Are We Ready? analyzes the impact of 9/11, the anthrax attacks that followed, and preparations for a possible smallpox attack on the nation's public health infrastructure. David Rosner and Gerald Markowitz interviewed local, state, and federal officials to determine the immediate reactions of key participants in these events. The authors explore the extent to which these emergencies permanently altered the political, cultural, and organizational life of the country and consider whether the nation is now better prepared to withstand another potentially devastating attack. This well-reasoned and well-researched book presents compelling evidence that few with hands-on experience with disease and emergency preparedness believe that an adequate response to terrorism—whether biological, chemical, or radiological—is possible without a strong and vibrant infrastructure to provide everyday services as well as emergency responses.

Are We Ready? begins with an examination of the experiences of local New York officials who were the first responders to 9/11 and follows them as events unfolded and as state and national authorities arrived. It goes on to analyze how various states dealt with changing federal funding for a variety of public health services. Using oral histories of CDC and other federal officials, the book then focuses on the federal reaction to 9/11 and anthrax. What emerges is a picture of dedicated public servants who were overcome by the emotions of the moment yet who were able to react in ways that significantly reduced the public anxiety and public health threat. Despite the extraordinary opportunity to revitalize and reinvigorate the nation’s public health infrastructure, the growing federal and state budget deficits, the refocusing of national attention on the war in Iraq, and the passage of time all combined to undermine many of the needed reforms to the nation’s public health defenses.

Cover

Title Page, Copyright

Contents

Foreword

The Milbank Memorial Fund is an endowed operating foundation that
works to improve health by helping decision makers in the public and
private sectors acquire and use the best available evidence to inform policy
for health care and population health. ...

Preface

This book was completed before the tragedy that destroyed much of
New Orleans and the Gulf Coast in the late summer of 2005, when
thousands were left homeless and hundreds dead after Hurricane Katrina
struck. Like those who responded to the attacks of September 11, 2001,
those on the ground in the days after the hurricane ...

Acknowledgments

The terrorist attacks on September 11, 2001, shocked all Americans. In
just a few moments our sense of safety shattered as four airplanes
attacked the American mainland for the first time in history. These
attacks and the concerns about the possibility of bioterrorism following
the anthrax episode a month later, ...

Introduction: Remembering the Moment

How can we understand the emotionally charged events surrounding
September 11, 2001? How can we begin to comprehend the impact on
our psyches, our institutions, and our people of the World Trade Center
collapse, the attack on the Pentagon, and the crash of a jetliner in the
fields of Pennsylvania? ...

1. September 11 and the Shifting Priorities of Public and Population Health in New York City

September 11, 2001, affected virtually all aspects of American life, from
foreign policy and domestic security to philanthropy, social services, and
health policy. Social welfare, public health, health care, and environmental
issues, generally seen as separate spheres, are now increasingly understood
as interrelated components ...

2. Emergency Preparedness, Bioterrorism, and the States

The newspaper headlines were stark and eerie: “Efforts to Calm the
Nation’s Fears Spin Out of Control,” “Local Public Health Officials Seek
Help,” “This Is Not a Test,” “State Can’t Handle Bioterrorist Attack,”
“Scared into Action.” And the pictures that accompanied them were
worse: investigators in moon suits; ..

3. Emergency Preparedness, Bioterrorism, and the CDC: Federal Involvement before and after 9/11

Public health activities have traditionally been understood as state and
local functions. Throughout the nineteenth and twentieth centuries, disease
surveillance and reporting, quarantine, vaccination campaigns, and
treatment—as well as sanitation and other preventive strategies—were
carried out largely by local and state health departments. ...

Conclusion: What Lessons Have We Learned?

What lessons are to be drawn from this historical account? September 11
presented the public health community and those involved with population
health more generally an immense opportunity to revitalize and
rethink the nation’s health agenda. ...

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